肩关节镜手术治疗青年初次肩关节前脱位的临床疗效分析

目的 探讨肩关节镜手术与传统保守方法治疗青年患者初次肩关节前脱位的临床疗效.方法 前瞻性纳入2012年-2016年在该院就诊的青年肩关节前脱位患者,共80例.其中,男49例,女31例,年龄18～40岁,平均(28.61±9.62)岁,所有患者入组前签署知情同意书,将患者随机分为A、B两组,每组各40例,A组采用肩关节镜...     

A Biomechanical Study of Bankart Lesion Fixation—Biodegradable ArthroRivet™ Tack vs. Suture Repair

Bioabsorbable fixation is commonly used in soft tissue procedures performed in the shoulder. ArthroRivet? tacks (referred to as rivets here), made from a copolymer of 82% poly-L-lactic acid and 18% polyglycolic acid, were developed for the Bankart procedure. Although a previous in vivo study demonstrated favorable comparison of the fixation strength and absorption characteristics of this device with that of polyglyconate bioabsorbable tacks, there have been no published biomechanical studies of this rivet in the shoulder. Fourteen shoulders were harvested from fresh-frozen cadavers of average age 74 years (46–89). Biomechanical testing was performed by measuring the energy, or work, required to anteriorly displace the humeral head 6 mm from the glenoid. Each shoulder was tested intact, vented, and before and after repair of a simulated Bankart lesion at 0, 45, and 90 degrees of abduction with and without maximal external rotation. Overall, the average work required ranged from 54.7 N-mm to 178.27 N-mm. Although the biomechanical performance of the rivet, based on resistance to anterior displacement of the humeral head, was indistinguishable from that of the suture repair, the statistical power of the test was low due to the large variance in the cadaver specimens. The results, in general, correlated well with those of previously published studies, suggesting the suitability of the bioabsorbable rivet for use in Bankart repair.     

Can capsular plication compensate the lack of one suture anchor in an arthroscopic three suture anchor Bankart repair? A comparative study

ObjectiveThe aim of this study was to compare the complication rates and clinical results of labral repair with two suture anchors and capsular plication, and labral repair with three suture anchor fixation in artroscopic Bankart surgery.MethodsSixty-nine patients (60 males, 9 females; mean age: 28.2 ± 7.8 years (range: 16–50)) who had undergone arthroscopic repair of a labral Bankart lesion were evaluated. Group A underwent an arthroscopic Bankart repair with three knotless suture anchors, while group B underwent a modified arthroscopic Bankart repair with two knotless suture anchors and an additional capsular plication procedure. The mean follow-up was 52.5 months. Constant Shoulder Score (CSS), Rowe Score (RS), modified UCLA Shoulder Score (mUSS) and range of motion (ROM) were used as outcome measures.ResultsIn both groups, a significant improvement was detected in functional outcomes at postoperative last follow-up compared to the preoperative period. No statistically significant difference was found (p > 0.05) in clinical scores (CSS; Group A: 89.7, Group B: 80.2) (RS; Group A: 88.2, Group B: 80.2) (mUSS; Group A: 26.3, Group B: 25.7) external rotation loss (At neutral; Group A: 4.5°, Group B: 5.2°. At abduction; Group A: 4.3°, Group B: 5.7°) and recurrence rates (Group A: 13.3%, Group B: 20.8%). Although the difference was not statistically significant, the recurrence rate was higher in group B (20.8%), compared to group A (13.3%), despite the shorter average follow-up time of group B (p = 0.417).ConclusionsArthroscopic repair of labral Bankart lesions with both techniques showed good functional outcomes and stability at the latest follow-up. Higher recurrence rate despite the shorter average follow-up of group B suggests that two anchor usage might not be sufficient for Bankart repair in terms of better stability and less recurrence risk.Level of evidenceLevel III, Therapeutic Study.     

Operative Management of Anterior Glenohumeral Instability

Abstract Introduction: Management of glenohumeral instability focuses more on operative treatment, while non-operative management, especially in young, active patients, may cause recurrent instability in a high percentage. Aim: Management of anterior glenohumeral instability, their advantages and limitations, the operative techniques and results will be described and discussed. Materials and Methods: A total of 379 patients who were operated between 1985 and 1994 for recurrent shoulder instability were followed up; 110 patients were managed with open Bankart procedure, 165 patients with arthroscopic Bankart and 98 patients were treated with a bone-block procedure. Follow-up evaluation was performed 53 months on average postoperatively. According to Rowe the functional results were classified as excellent and good in 91% with the open Bankart procedure, 80.6% with the arthroscopic Bankart repair and the results using the bone-block were rated as excellent and good in 95.4%. Overall complication rate was 16.3% (arthroscopic), 6.4% (open Bankart) and 4.4% (bone-block group). In patients with long-time results, degenerative signs at the glenoid and/or the humeral head were evaluated on plane radiographs (according to Rosenberg). In 17 long-term results of the bone-block procedure, Stage I osteoarthritis was identified in 25.5%, but no severe osteoarthrosis (stage II or III), while in the open Bankart group an osteoarthrosis rate of 18.6% (stages II and III) was found. Conclusion: Different types and causes of glenohumeral instability recommend different techniques for operative treatment of anterior glenohumeral instability. The bone-block procedure provided the best results regarding stability and function; long-term radiological results indicate that bony repair prevents and does not cause osteoarthrosis.